8.5 Summary Comparison Report
The Summary Comparison Report provides an overview of the modeled plan's effect on the overall cost for the plan sponsor and member. The amounts as they were originally adjudicated are displayed in the Actual Plan column while the readjudicated amounts are displayed in the Model Plan column; the amount of change between the actual and model plans are displayed as raw dollars and percentage of change.
Billed Charges - Total amount billed by providers before network discount or other types of savings. This value should always be the same for both the actual and modeled plans (i.e., Change should always be $0).
Discount - The amount of savings from PPO and other discount outlets. This value should always be the same for both the actual and modeled plans.
Member Deductible - The total deductible amount paid by the member. This does not include member copay, which is sometimes referred to as a "per-charge deductible".
Member Copay - The total amount paid by the member in per visit / per charge copay.
Member Coinsurance - The total amount paid by the member in coinsurance.
Plan Cost - The total amount paid by the plan.